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Oregon Department of Environmental Quality * Dosing tank capacity. 500 GALLONS * Tank volume determined by:Check all that apply,add comments below as needed. x Permit Records x Measured Stamped on Tank Other * Dosing tank material CONCRETE * Dosing tank appears to be watertight and in good condition x Yes No * Dosing tank lid is intact x Yes No * Electrical components are sealed and watertight x Yes No * Pump/siphon is functional Yes No X UNKNOWN * Type of Pump x Demand dose Time dose * Pump control mechanism is functional(floats,pressure transducer) Yes x UNKNOWN * There is a high water alarm x Yes No * The high water alarm(audible and visual)is working Yes No x UNKNOWN * Type of screen BLACK SCREEN * Screen is clean and free of debris x Yes No * Screen cleaned for this evaluation x Yes No * Scum/sludge present in Dosing tank x Yes No * Scum layer 0 (inches) Sludge layer 6 (inches) * Additional Comments: NO POWER AVAILABLE AT THE TIME OF EVALUATION TO TEST ELECTRIC COMPONENT. 5. Soil absorption system The soil absorption system is a set of trenches that receives effluent from the septic tank and filters the effluent before it enters the groundwater. * The septic system has a soil absorption system x Yes No Unknown * Was the soil absorption system part of the evaluation? x Yes No See note below If the soil absorption system was not evaluated,please explain below(for example unable to locate,client did not authorize this part of the evaluation): * Absorption distribution Equal x Serial Pressure Equal via pressure * Absorption lines construction material: x Gravel and pipe Chamber Tile Polystyrene foam and pipe Other * Absorption distribution unit(s): x dropbox hydrosplitter equal distribution box Intact x Damaged N/A * Absorption distribution unit(s)are free of debris or solids Yes x No N/A Page 4 of 8